[Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy.] / Factores relacionados al paciente que afectan la limpieza del colon previo a la colonoscopia.

INTRODUCTION: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. OBJECTIVES: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. MATERIALS AND METHODS: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. RESULTS: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. CONCLUSIONS: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.

[Pilot test for Helicobacter pylori detection with ammonia breath test]. / Prueba piloto para la detección de Helicobacter pylori con test de amoníaco en aire espirado.

BACKGROUND: In Argentina we have little access to the more sensitive and specific non-invasive diagnostic methods for the detection of Helicobacter pylori (HP), such as the urea breath test. The upper gastrointestinal videoendoscopy, with biopsy for histological analysis and rapid urease test remains as the usual method in our country, but the cost is high and the accessibility is also limited. For this reason we propose to develop a new fast, accurate, accessible and inexpensive method for measuring the concentration of expired NH in order to achieve a diagnosis of active infection. OBJECTIVE: To determine the utility of a non-invasive method for detecting HP through the measurement of ammonia in the breathing. MATERIALS AND METHODS: We studied 3 patients older than 21 years, attending the Gastroenterology clinic. All patients who meet the inclusion criteria were evaluated with an upper gastrointestinal videoendoscopy and gastric biopsies (antrum, body and incisura angularis). Samples were analyzed by histopathological examination and urease test. The subjects with both negative tests (non-infected) or positive (infected) were selected for ammonia measurement in exhaled air. RESULTS: The prevalence of HP infection was 60.9% (14 patients). Ten of these patients had significant differences between the baseline ammonia and the ammonia after urea ingestion, yielding a specifcity of 88.9% and a sensitivity of 71.43%, with a Jouden index higher than 50%. CONCLUSION: Although the experience must be carried forward, the results of this pilot study suggest that the measurement of ammonia in breath test after ingestion of unmarked urea would be applicable as a diagnostic test for HP, taking into account its low cost and easy management compared to conventional non-invasive methods.

[Pancreatic intraductal papillary mucinous neoplasm: Case report and review of the literature]. / Neoplasia mucinosa intraductal papilar del páncreas: Comunicación de un caso y revisión de la literature.

Pancreatic intraductal papillary mucinous neoplasias (IPMN) are increasingly detected in medical diary practice because of increased awareness of their existence and because of increased use of cross-sectional imaging studies. IPMN are diagnosed incidentally in most cases and are classified as branch-duct IPMN, main-duct IPMN and combined-type IPMN. The last two types show a more aggressive biological behavior and surgery is recommended. Moreover, there are four subtypes of neoplastic epithelium in these tumours (intestinal, pancreatobiliary, gastric and oncocytic), which determine differences in the natural history of these neoplasms and this also seems to have prognostic relevance. We report a case of a patient who underwent a pancreatoduodenectomy due to a combined-type IPMN and whose anatomopathological study revealed an intestinal subtype IPMN with high grade dysplasia and colloid carcinoma. We also review the literature and describe the main aspects of this particular type ofcystic pancreatic tumours.

[Influence of proton pump inhibitors on intestinal fermentative profile: a case-control study]. / Impacto del uso de inhibidores de la bomba de protones sobre el perfil fermentativo intestinal: Un estudio de tipo caso-control.

INTRODUCTION: Proton pump inhibitors could have an impact on the results of breath tests performed in patients with irritable bowel syndrome. This impact could be due to the development of small intestine bacterial overgrowth. OBJECTIVE: To compare the prevalence of fermentative profile alterations of irritable bowel syndrome patients exposed and not-exposed to proton pump inhibitor therapy. MATERIAL AND METHODS: Subjects with irritable bowel syndrome were enrolled. A validated questionnaire assessing symptom severity as well as proton pump inhibitor treatment was delivered. A lactulose breath test was undertaken by each enrolled subject. Fermentative profile (area under the curve of hydrogen excretion/time) was compared between proton pump inhibitors consumers and non-consumers. Furthermore, small intestine bacterial overgrowth prevalence was compared. RESULTS: Two hundred and twenty five patients were enrolled. No significant differences were found on the fermentative profile between groups [AUC mediana 3,776 (rango 2,124-5,571) vs 4,347 (rango 2,038-5,481), P = 0.3]. Small intestine bacterial overgrowth prevalence was similar as well [33% vs 27.5%]. These differences remained non-significant after adjusting for proton pump inhibitor dose and treatment time. Surprisingly, symptom score was significantly higher in those patients under proton pump inhibitor therapy [28.5 (23-26) vs 23 (15-29), P = 0.01]. CONCLUSION: Proton pump inhibitors have no significant influence on lactulose breath tests, regardless of the dosage and time of administration.

A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet.

BACKGROUND AND AIMS: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. METHODS: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. RESULTS: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. CONCLUSIONS: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.

[Predominance of constipation in subjects with hydrogen-consuming intestinal flora]. / Tendencia al estreñimiento en sujetos que presentan predominio de microorganismos intestinales consumidores de hidrógeno.

INTRODUCTION: There is growing evidence that a disorder in intestinal microbiota would contribute to the development of symptoms in irritable bowel syndrome (IBS) patients. In a subgroup, a remarkably low hydrogen production in lactulose breath test (LBT) is observed. We presume in these patients a predominance of hydrogen consuming gut flora. OBJECTIVE: [corrected] Describe the clinical presentation of lBS patients with low hydrogen production and to compare their cathartic pattern against those with high hydrogen excretion. MATERIALS AND METHODS: A case-control study was designed. IBS outpatients were included. A validated questionnaire was delivered (IBSSS) in order to assess their symptoms and a LBT was performed. The cathartic pattern was compared between those with low and high hydrogen production on LBT. RESULTS: One hundred and ten patients were included and 15 of them (13.6%) had low hydrogen production on LBT, which would be compatible with the presence of hydrogen-consuming gut flora. In this group, 11 patients (73.33%) were constipated In contrast, only 30 patients (31.58%) in the high or normal hydrogen production group were constipated [OR 5.95 (95% confidence interval 1.75-20.25; P = 0.03)]. CONCLUSION: IBS patients with low hydrogen production on lactulose breath test were 6 times more frequently constipated.

[Variation of intestinal fermentative profile after sequential therapy with rifaximin/probiotics]. / Variaciones del perfil fermentativo intestinal frente al uso de un esquema terapéutico secuencial: rifaximina/probiótico.

INTRODUCTION: There is evidence suggesting that intestinal microbiota plays a role in the development of irritable bowel syndrome. Its activity can be indirectly assessed using the lactulose breath test. Antibiotics like rifaximin or probiotics can be used as therapeutic options for patients with irritable bowel syndrome. Our purpose was to evaluate the efficacy of a sequential treatment with rifaximin and probiotics in these patients. MATERIAL AND METHODS: We prospectively evaluated patients with diagnosis of irritable bowel syndrome according to Rome III criteria. Included patients had to fill in a questionnaire in order to assess their symptoms severity. A lactulose breath test was also performed in each case and a curve with the results of hydrogen concentration and time was elaborated. Then, the area under the curve was calculated After initial evaluation, patients received a seven-day treatment with rifaximin, followed by a ten-day course of probiotics. Thirty days after completion of treatment a new lactulose breath test along with a questionnaire were performed. RESULTS: We included 15 patients and 93% experienced a significant improvement of their symptoms as well as a significant reduction of the lactulose breath test values. CONCLUSION: Sequential treatment with rifaximin/probiotics seems to be effective for symptom and fermentative profile improvement in irritable bowel syndrome patients.

[Symptomatic correlation variables in patients with pathological gastroesophageal reflux disease]. / Variables de correlación sintomática en pacientes con reflujo gastroesofágico patológico.

UNLABELLED: INTRODUCTION. There are three indexes that correlate symptoms and reflux episodes in pHmetry tests. The utility of these indexes have been evaluated in prospective trials but their advantages and disadvantages remain controversial. OBJECTIVE: To assess the clinical utility of the pHmetric symptomatic correlation indexes in patients with pathological acid reflux. MATERIAL AND METHODS: A sequential pilot study of pHmetry tests was performed between September 2008 and June 2010. Twenty patients with gastroesophageal reflux and a DeMeester score above 14.5 were included. For the analysis, a distinction was made between strong acid reflux episodes (pH < 4) and weak acid reflux episodes (pH < 7 and > 4). The following indexes were calculated for both groups mentioned before: symptom index (SI), symptom sensitivity index (SSI) and symptom association probability (SAP). RESULTS: The mean age was 54 and 55% of patients were male. There were 116 symptomatic episodes (mean 5.8 per patient), 1,634 strong acid reflux episodes and 555 weak acid reflux episodes. Twelve (60%) had positive SI for strong acid reflux. Twelve had positive SSI for strong acid reflux and 91.66% of them had positive SI. Only 4 patients had a positive SAP. Only 2 patients had a positive SI for weak acid reflux and none of them had either a positive SI for strong acid reflux or a positive SAP for weak acid reflux. Finally, 30% of patients had a positive SSI for weak acid reflux. CONCLUSION: Positive correlation was significantly higher in strong acid rather than in weak acid reflux. SAP was the index with the lowest percentage of positivity. On the other hand, there was a high concordance between SI and SSI. Thus, the PAS index does not seem to have enough clinical utility in this cohort of patients.

[Frequency of bacterial overgrowth in patients with clinical lactose intolerance]. / Frecuencia de sobrecrecimiento bacteriano en pacientes con intolerancia clínica a la lactosa.

INTRODUCTION: Some patients complain of digestive symptoms related to diary products intake. This intolerance could be associated with an intestinal bacterial overgrowth or an increased fermentative intestinal profile and not due to lactose malabsorption. OBJECTIVE: To estimate the prevalence of bacterial overgrowth in subjects with digestive symptoms related to diary products intolerance. MATERIAL AND METHODS: Patients who had performed hydrogen breath test due to chronic functional distension syndrome (Rome III) were analyzed. Thirty of them (22 female, average age 52 years) complained of symptoms related to diary products intake. All subjects completed a nutritional survey that allowed to assess the degree of tolerance to milk products and performed the hydrogen breath test with lactulose as substrate. Bacterial overgrowth was considered when baseline values were over 15 parts per million (ppm), values before 80 minutes were greater than 20 ppm or values of area under the curve were greater than 3,000 ppm/min in the 180 studied minutes. RESULTS: Fifty four patients were analyzed. Thirty of them showed moderate, important or severe clinical milk intolerance. Of these patients, 23 (77%), had a positive breath hydrogen test according to used criteria. CONCLUSIONS: The prevalence of small bowel bacterial overgrowth or an increased fermentative intestinal profile among individuals who complain of symptoms related to diary products is high and this fact should be considered in order to avoid empirical restrictive diets.

[Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study]. / Eficacia comparativa de un probiótico vs un antibiótico en la respuesta clínica de pacientes con sobrecrecimiento bacteriano del intestino y distensión abdominal crónica funcional: un estudio piloto.

INTRODUCTION: Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibiotics. Certain probiotics have proved to be clinically effective in patients with abdominal distension. OBJECTIVE: To compare the short-term clinical efficacy of metronidazol vs. a probiotic in patients with SIBO and functional chronic abdominal distension. Patients and methods. This was a randomized prospective pilot study. The study population consisted of 50 patients with chronic abdominal distension (Rome III criteria) and diagnosis of SIBO made by a lactulose H2 breath test. Patients were consecutively randomized to receive either metronidazol or a probiotic. The metronidazol group consisted of 25 subjects (23 women, median age 49 +/- 19 years old), who received metronidazol (Flagyl), 500 mg bid for 5 days. The probiotic group consisted of 25 subjects (20 women, median age 58 +/- 19 years old). The probiotic administered to the latter group contained Lactobacillus casei (3.3 x 10(7) UFC), Lactobacillus plantarum (3.3 x 10(7) UFC), Streptococcus faecalis (3.3 x 10(7) UFC) and Bifidobacterium brevis (1.0 x 10(6) UFC) (Bioflora) and 5 ml bid were administered for 5 days. Both groups went on the same diet, which consisted in reduced consumption of alcohol, legumes, dairy products and leafy green vegetables. Response to treatment was assessed by an independent questioner 15 days post treatment. A five-level overall response questionnaire was used. Responses included much better, better, the same, worse, and much worse. Better and much better were considered positive responses. RESULTS: Thirteen (52%) subjects receiving metronidazol and 20 (82%) receiving the probiotic referred clinical improvement after the treatment. A statistically significant difference favoured the use of the probiotic (P = 0.036). All the study patients completed treatment. No adverse events leading to treatment discontinuation were observed. CONCLUSIONS: Based on this pilot study results, we can suggest that the probiotic herein used has a higher efficacy than metronidazol in the early clinical response of patients with chronic abdominal distension and SIBO.

[On-demand treatment of nonerosive reflux disease: omeprazole plus bicarbonate powder versus omeprazole capsules]. / Terapia a demanda en el reflujo gastroesofágico no erosivo: omeprazol + bicarbonato polvo versus omeprazol cápsulas.

BACKGROUND: Nonerosive reflux disease (NERD) has a chronic and benign course. On-demand therapy would constitute a useful strategy for its management. OBJECTIVE: To assess efficacy of on-demand treatment with omeprazole powder (OBA: omeprazole 20 mg, sodium bicarbonate 1680 mg, alginic acid 250 mg) versus omeprazole capsules 20 mg (OMZ) in the control of symptoms. METHOD: In this multicenter, open-label, randomized, crossover study, patients with NERD, of both genders and 21 to 65 years old, were included. They underwent alternate treatments, 42 days with each pharmaceutical form (PF), wash out 6 days, beginning with a cycle of 7 consecutive days after the first symptomatic manifestation and repeating the same cycles in the event of similar circumstances. Efficacy was assessed with patient global impression (PGI), visual analogue scale (VAS) for heartburn and time to relieve symptoms. Tolerability was assessed. RESULTS: Forty-eight patients (40 women, average age 37 years old) entered the study. Both PF were effective according to PGI: 98% with OBA and 92% with OMZ. VAS for heartburn was: baseline 7.29 +/- 1.51; post-OMZ 2.82 +/- 1.85; post-OBA 2.25 +/- 1.61. The percentage of patients who received 7 days' cycles with each treatment were: OMZ 1-2: 29.17%; 3-4: 58.33%; 5-6: 12.5%; OBA 1-2: 43.75%; 3-4: 52.08%; 5-6: 4.17%. Dose was doubled in 35% of cases. OBA acted faster than OMZ for 83% of the patients (87 min versus 140 min, P < 0.01). Both PF were well tolerated. CONCLUSIONS: On-demand treatment of NERD with omeprazole in cycles of 7 days was equally effective for both PE OBA acted faster to relieve symptoms.

[Acid suppression capacity of omeprazole, sodium bicarbonate and alginic acid in an oral powder combination]. / Capacidad acidosupresora de omeprazol, bicarbonato de sodio y alginato de sodio en polvo para suspensión oral.

BACKGROUND: The combination of omeprazole, sodium bicarbonate and alginic acid protects omeprazole from acid degradation and enhances the speed of action of the proton pump inhibitors. AIM: To assess acid suppression capacity and speed of action of an oral powder combination (omeprazole 20 mg, sodium bicarbonate 1680 mg and alginic acid 250.08 mg) in healthy subjects, using gastric 24 h pHmetry. SUBJECTS AND METHODS: Gastric 24 h pHmetry was performed in 13 healthy subjects on days 0 and 6. During the first pHmetry, 7 subjects received the combination 2 h before the end of the procedure. The second study was performed after the subjects had been administered the medication for the six previous days. The measurements were: a) time with pH < 4, b) time to reach maximum pH value, and c) pH peak after first drug administration. RESULTS: The percentage of time with pH < 4 was 72.02 +/- 20.18 in the first study and 34.05 +/- 20.50 in the second (p < 0.01). Maximum pH obtained after first drug administration was 6.98 +/- 1.66 and the time to reach the pH peak was 18.34 +/- 9.84 minutes. CONCLUSION: This oral powder combination induces significant, fast and intensive gastric acid suppression. Unlike delayed-release proton pump inhibitors, this product provides a faster but equally sustained control of gastric acidity.

[Breath hydrogen levels do not predict fiber intolerance in irritable bowel syndrome with constipation]. / El incremento del hidrógeno en el aire espirado no predice la intolerancia a la fibra en la dieta en el síndrome del intestino irritable con constipación. Estudio piloto.

BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.

[Diagnostic and therapeutic algorithm in functional dyspepsia]. / Algoritmo diagnóstico y terapéutico para la dispepsia funcional.

INTRODUCTION: Dyspepsia is a word that means bad digestion. In the conviction of which it is a question of an entity that it includes different disciplines, we realize a meeting consensus to discuss and to resolve a diagnostic and therapeutic algorithm of national order. OBJECTIVE: To agree on a national algorithm applicable to the functional dyspepsia. MATERIAL AND METHODS: In June 2005 a multidisciplinary group met to design and to propose a diagnostic and therapeutic algorithm for the functional dyspepsia. RESULTS: Priority gives to the medical-patient relationship and to the reinsurance. Then we divide the patients if they have signs of alarm. If they are present we studied them, if not we divide them, in accordance to the principal symptoms, in pain or epigastric discomfort. If they have pain we realized an endoscopy and a abdominal ultrasound scan. If they are positive, treatment of the disease. If the studies are negative or it has epigastric discomfort we propose a therapeutic test. Pain: H2 bloquers, wait 4 to 6 weeks, if it not response we propose a PPI, wait for 4 to 6 weeks, if there is no response psychiatric or psychological consultation. Discomfort: proquinetics, wait for 4 to 6 weeks if there are no answers, antidepressants in low doses, wait for 4 to 6 weeks if there are no answers, ca. bloquers, sumatriptan or trimebutina. In all cases we can add tranquillizers in anxious personality. CONCLUSIONS: A multidisciplinary dignostic and therapeutic consensus of national order for the patients with functional dyspepsia was obtained.

[Clinical-phmetric variants in gastroesophageal reflux disease]. / Variantes clínico-phmétricas en la enfermedad por reflujo gastroesofágico.

BACKGROUND: Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. AIM: To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. PATIENTS AND METHODS: [corrected] During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologic acid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR). RESULTS: 18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P = 0.0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and probably they should be evaluated and treated in a different way.